Responsibility: Find out What it Means to Me
Being accountable in the medical profession sounds simple enough – but often times it’s not practiced as it should be. KUNC commentator Dr. Marc Ringel has found one movement that’s empowering its patients to hold doctors accountable in their treatment.
One thing I don’t miss about the family practice in Brush that I left last summer is the frequent frustration that comes with seeing a patient with multiple complaints and diagnoses, incomplete health screenings and immunizations, and missing information in his medical record, all in a 15 to 30 minute visit, maybe our first encounter in a couple of years.
I’ve spoken before about the movement to the patient-centered medical home (PCMH) that is gaining a real foothold in the effort to reorganize patient care so as to do a much more efficient and comprehensive job of addressing the wellness and medical care of each patient.
Last week, as part of a program called “Parade of Medical Homes,” sponsored by the Colorado Academy of Family Physicians, I got to visit a practice that is three years along the way in transforming itself into a PCMH. Rather than try to describe the numerous amazing (and wholly logical) structural reforms they’ve made, I’d rather focus on just one concept, responsibility.
Here’s the single thing that impressed me most in my two-hour tour. Our small group was interviewing the woman who makes about fifty appointments a week, with specialists and testing centers, for patients in the practice. Our home tour guide urged the referral scheduler to tell the story of a woman with a breast lump. After numerous calls from the scheduler over a couple of months to remind her about the mammogram she’d been too frightened to get, the patient relented and had her study. A suspicious lesion was found. She saw a surgeon the next day and very soon after had cancer surgery that probably saved her life.
Our host doctor asked his employee, who spends her day on the phone with her back to the patient care area, “Whose patient is she?”
Without missing a beat, the scheduler, someone who would be classified as office staff (as opposed to clinical staff) in most any other practice, responded unselfconsciously, “My patient.”
Now that’s responsibility!
When faced with the problem of getting reports back from specialists, some of whom didn’t respond to multiple reminders, the practice decided to engage patients in training referral physicians about how to treat them and their medical home. The home developed a referral form that the doctor or medical assistant spends a few minutes filling out and explaining to the patient. This half-sheet outlines the medical issues relevant to the consult and the expected outcome, including communication with patient and practice. The patient brings the form with her to her appointment and is urged to discuss its contents with the doctor.
In other words, holding true to a cornerstone of the medical home concept, responsibility for care is shared by everybody, in this instance, by patient and consultant and home. It’s working. The home practice is getting significantly better service and communication from specialists.
There are huge centrifugal forces in our current health care non-system that keeps us from sharing responsibility, including: the traditional dependent posture of patients, complimented by the paternalistic attitude of doctors; a medical culture marked by a rigid hierarchy that runs from housekeeper up to subspecialist surgeon; and about two-and-a-half trillion dollars a year. However, in PCMH and similar efforts I’m seeing glimmers of real reform. These changes that will make everybody’s life better, including my professional one, because I’ll get to share the awful burden of responsibility in a life-and-death business.
I’d like to work in a medical home. A good place to start would be, as a patient, to seek out a medical home for myself. Being cared for in a PCMH would give me the best odds of living long enough and staying well enough to someday practice in one.